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Article(id=1324051016047534719, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512496, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1766851200000, receivedDateStr=2025-12-28, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607961903, onlineDateStr=2026-11-02, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607961903, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607961903, creator=13701087609, updateTime=1793607961903, updator=13701087609, issue=Issue{id=1324050876230415089, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607928569, creator='13701087609', updateTime=1793670049253, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311429322507008, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311429322507009, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050876230415089, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2081, endPage=2087, ext={EN=ArticleExt(id=1324051017775587968, articleId=1324051016047534719, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Influencing factors of parents’ willingness to vaccinate children with non-expanded program on immunization vaccines—a social ecosystem theory perspective, columnId=1228016573156360233, journalTitle=Modern Preventive Medicine, columnName=Disease Control and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

Based on social ecosystem theory (SET), this study investigated parents’ willingness to vaccinate their children with non-expanded program on immunization (non-EPI) vaccines and its influencing factors.

Methods

In August 2024, a cross-sectional study was conducted using a self-designed questionnaire based on the core framework of SET through an online questionnaire to assess the willingness of parents in Chengdu to vaccinate children aged 0-6 years with non-EPI vaccines. Multivariable logistic regression analysis was employed to identify factors influencing willingness to vaccinate children with non-EPI vaccines.

Results

A total of 3 448 valid questionnaires were collected, with 46.1% of parents expressing willingness to vaccinate children with non-EPI vaccines. At the micro level, perceived benefits were positively associated with parental willingness to vaccinate their children with non-EPI vaccines (OR=2.60, 95% CI: 2.20-3.07), while risk underestimation was negatively associated with parental willingness (OR=0.68, 95% CI: 0.58-0.79). At the meso level, favorable economic conditions (OR=1.25, 95% CI: 1.07-1.46), good vaccine service accessibility (OR=2.70, 95% CI: 2.31-3.15), and peer recommendations (OR=1.30, 95% CI: 1.11-1.52) were positively associated with parental willingness. Conversely, healthcare workers’ recommendations were negatively associated with parental willingness (OR=0.82, 95% CI: 0.69-0.97). At the macro level, trust in media reports of vaccine-related negative news was negatively associated with parental willingness (OR=0.79, 95% CI: 0.68-0.92), while preferential vaccination policies were positively associated with parental willingness (OR=2.13, 95% CI: 1.75-2.60).

Conclusion

Parents’ willingness to vaccinate children with non-EPI vaccines is influenced by factors at micro, meso and macro levels. Future interventions aimed at increasing vaccination rates for non-EPI vaccines should consider multi-level coordinated interventions.

, authors=Xue-qing PENG, Liang-zhi ZHANG, Ming-yue GAO, Lei LI, authorsList=Xue-qing PENG, Liang-zhi ZHANG, Ming-yue GAO, Lei LI, authorCompany=null, correspAuthors=Lei LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324051018673169031, articleId=1324051016047534719, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=社会生态学视角下家长对儿童非免疫规划疫苗接种意愿影响因素分析, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

基于社会生态学理论（social ecosystem theory， SET）探究家长对儿童非免疫规划疫苗接种意愿及其影响因素。

方法

2024年8月，采用基于SET核心框架的自设问卷，通过在线问卷调查对成都市0～6岁儿童家长非免疫规划疫苗接种意愿情况开展横断面研究。利用多因素logistic回归分析影响非免疫规划疫苗接种意愿的因素。

结果

共收集3 448份有效问卷，46.1%的家长有为儿童接种非免疫规划疫苗的意愿。在微观层面，益处认知与家长为儿童接种非免疫规划疫苗的意愿呈正向关联（OR=2.60，95%CI：2.20～3.07），而低估风险认知与家长意愿呈负向关联（OR=0.68， 95%CI：0.58～0.79）；在中观层面，经济状况较好（OR=1.25， 95%CI：1.07～1.46）、疫苗接种服务可及性好（OR=2.70， 95%CI：2.31～3.15）、同伴的推荐（OR=1.30， 95%CI：1.11～1.52）与家长意愿呈正向关联，但医务工作者的建议与家长意愿呈负向关联（OR=0.82， 95%CI：0.69～0.97）。在宏观层面，信任媒体报导的疫苗负面消息与家长意愿呈负向关联（OR=0.79， 95%CI：0.68～0.92），而疫苗接种优惠政策与家长意愿呈正向关联（OR=2.13， 95%CI：1.75～2.60）。

结论

家长对儿童非免疫规划疫苗接种意愿受微观、中观、宏观多层嵌套关联的因素共同影响，未来有关提升儿童非免疫规划疫苗接种率的干预措施应考虑多层次的协同干预。

, authors=彭雪清, 张量智, 高明月, 李蕾, authorsList=彭雪清, 张量智, 高明月, 李蕾, authorCompany=null, correspAuthors=李蕾, authorNote=

彭雪清（1995—），女，硕士，医师，研究方向：疫苗可预防疾病控制与健康教育研究

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李蕾，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=6f9/t4RRkRYB/l2e9h9lZg==, magXml=esEsK39ZMNoAZuulFzdj4Q==, pdfUrl=null, pdf=RXEldMqZxs8aa9xCDGId+A==, pdfFileSize=934510, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=7sdG37nCYlg2CXgfpw4fbw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=rBl5kxxNva7AdMysH1nw5Q==, mapNumber=null, fund=null)}, authors=[Author(id=1324051019491058316, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1324051019591721614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, authorId=1324051019491058316, language=EN, stringName=Xue-qing PENG, firstName=Xue-qing, middleName=null, lastName=PENG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=Department of Immunization Planning, Chengdu Center for Disease Control and Prevention (Chengdu Institute of Health Supervision), Chengdu, Sichuan 610041, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324051019931460239, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, authorId=1324051019491058316, language=CN, stringName=彭雪清, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=null, address=成都市疾病预防控制中心（成都市卫生监督所）免疫规划科，四川 成都 610041, bio={"content":"

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Investigation on the influence of Changchun Changsheng vaccine incident on the attitude of category vaccines of children's parents in Xuzhou city[J]. Chinese Health Service Management, 2020, 37(4): 312-316.(In Chinese), articleTitle=Investigation on the influence of Changchun Changsheng vaccine incident on the attitude of category vaccines of children's parents in Xuzhou city, refAbstract=null), Reference(id=1324051029343478486, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, doi=null, pmid=null, pmcid=null, year=2023, volume=16, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[23], rfOrder=33, authorNames=Brune C, Agerholm J, Liljas A, journalName=Health Serv Insights, refType=null, unstructuredReference=Brune C, Agerholm J, Liljas A. Medical doctors' perceptions of the media coverage during the covid-19 pandemic: a case study in Stockholm[J]. Health Serv Insights, 2023, 16: 11786329231222168., articleTitle=Medical doctors' perceptions of the media coverage during the covid-19 pandemic: a case study in Stockholm, refAbstract=null), Reference(id=1324051029423170263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=11, pageStart=1540, pageEnd=1544, url=null, language=null, rfNumber=[24], rfOrder=34, authorNames=徐娟, 邓景景, 栾琳, journalName=职业与健康, refType=null, unstructuredReference=徐娟，邓景景，栾琳，等. 2017—2020年苏州市地方扩大免疫规划项目实施情况报告[J].职业与健康，2022，38（11）：1540-1544., articleTitle=2017—2020年苏州市地方扩大免疫规划项目实施情况报告, refAbstract=null), Reference(id=1324051031180583640, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, doi=null, pmid=null, pmcid=null, year=2022, volume=38, issue=11, pageStart=1540, pageEnd=1544, url=null, language=null, rfNumber=[24], rfOrder=35, authorNames=Xu J, Deng JJ, Luan L, journalName=Occupation and Health, refType=null, unstructuredReference=Xu J, Deng JJ, Luan L, et al. Report on the implementation of local expanded programme on immunization in Suzhou City from 2017-2020[J]. Occupation and Health, 2022, 38(11): 1540-1544.(In Chinese), articleTitle=Report on the implementation of local expanded programme on immunization in Suzhou City from 2017-2020, refAbstract=null)], funds=[Fund(id=1324051024826213044, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, awardId=20240206, language=CN, fundingSource=成都市疾病预防控制中心2024年度科研课题(20240206), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324051019142931080, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, xref=null, ext=[AuthorCompanyExt(id=1324051019163902601, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, companyId=1324051019142931080, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Immunization Planning, Chengdu Center for Disease Control and Prevention (Chengdu Institute of Health Supervision), Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1324051019176485514, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, companyId=1324051019142931080, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=成都市疾病预防控制中心（成都市卫生监督所）免疫规划科，四川 成都 610041)])], figs=[ArticleFig(id=1324051023823774378, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=EN, label=Figure 1, caption=The constructs of the non-EPI vaccination willingness based on SET, figureFileSmall=65Ub28cW+8uF6Yj9Ku5Rdw==, figureFileBig=7sdG37nCYlg2CXgfpw4fbw==, tableContent=null), ArticleFig(id=1324051023886688939, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=CN, label=图1, caption=基于SET的非免疫规划疫苗接种意愿理论框架, figureFileSmall=65Ub28cW+8uF6Yj9Ku5Rdw==, figureFileBig=7sdG37nCYlg2CXgfpw4fbw==, tableContent=null), ArticleFig(id=1324051024096404140, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=EN, label=Table 1, caption=

Basic characteristics and non-EPI vaccination willingness (n=3 448)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目人数占比（%）
年龄（岁）32（29, 35）
性别
男37310.8
女3 07589.2
文化程度
初中及以下84424.5
高中/中专/技校87925.5
大专/本科1 61646.9
研究生及以上1093.2
职业
企事业单位人员（不含医疗机构）91226.5
医务工作者3189.2
自由职业/个体经营者1 13833.0
农/牧民852.5
其他50114.5
无业/家务待业49414.3
前一年家庭年总收入（万元）
<102 18563.4
≥101 26336.6
儿童健康状况
差60317.5
好2 84582.5
儿童家长健康状况
差89726.0
好2 55174.0
疫苗接种意愿
不愿意1 85953.9
愿意1 58946.1
), ArticleFig(id=1324051024176095917, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=CN, label=表1, caption=

基本特征及疫苗接种意愿情况（n=3 448）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目人数占比（%）
年龄（岁）32（29, 35）
性别
男37310.8
女3 07589.2
文化程度
初中及以下84424.5
高中/中专/技校87925.5
大专/本科1 61646.9
研究生及以上1093.2
职业
企事业单位人员（不含医疗机构）91226.5
医务工作者3189.2
自由职业/个体经营者1 13833.0
农/牧民852.5
其他50114.5
无业/家务待业49414.3
前一年家庭年总收入（万元）
<102 18563.4
≥101 26336.6
儿童健康状况
差60317.5
好2 84582.5
儿童家长健康状况
差89726.0
好2 55174.0
疫苗接种意愿
不愿意1 85953.9
愿意1 58946.1
), ArticleFig(id=1324051024251593390, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=EN, label=Table 2, caption=

Basic information of SET related influencing factors（n=3 448）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目人数占比（%）
微观层面
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否1 31238.1
是2 13661.9
安全性认知-我担心非免疫规划疫苗会产生副作用
否1 75650.9
是1 69249.1
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否2 22664.6
是1 22235.4
中观层面
家庭医疗费用负担
有负担1 97057.1
没有负担1 47842.9
预防接种单位人员服务态度
不好65118.9
好2 79781.1
接种单位服务时间能满足接种疫苗需求
不能1684.9
能3 28095.1
距离住家最近预防接种单位的路程（min）
>2050214.6
≤202 94685.4
能随时接种到打算为孩子接种的非免疫规划疫苗
否1 81952.8
是1 62947.2
家人、朋友或同事推荐接种
否1 43241.5
是2 01658.5
医务工作者建议接种
否1 00829.2
是2 44070.8
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否1 41040.9
是2 03859.1
国家对疫苗质量监督管理
否1 48443.0
是1 96457.0
国家或政府实施疫苗接种优惠政策
否86625.1
是2 58274.9
), ArticleFig(id=1324051024352256687, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=CN, label=表2, caption=

SET相关影响因素的基本情况（n=3 448）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目人数占比（%）
微观层面
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否1 31238.1
是2 13661.9
安全性认知-我担心非免疫规划疫苗会产生副作用
否1 75650.9
是1 69249.1
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否2 22664.6
是1 22235.4
中观层面
家庭医疗费用负担
有负担1 97057.1
没有负担1 47842.9
预防接种单位人员服务态度
不好65118.9
好2 79781.1
接种单位服务时间能满足接种疫苗需求
不能1684.9
能3 28095.1
距离住家最近预防接种单位的路程（min）
>2050214.6
≤202 94685.4
能随时接种到打算为孩子接种的非免疫规划疫苗
否1 81952.8
是1 62947.2
家人、朋友或同事推荐接种
否1 43241.5
是2 01658.5
医务工作者建议接种
否1 00829.2
是2 44070.8
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否1 41040.9
是2 03859.1
国家对疫苗质量监督管理
否1 48443.0
是1 96457.0
国家或政府实施疫苗接种优惠政策
否86625.1
是2 58274.9
), ArticleFig(id=1324051024427754160, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=EN, label=Table 3, caption=

Univariate analysis of parents’ willingness to vaccinate children with non-EPI vaccines ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量疫苗接种意愿
不愿意愿意χ2/z值P值
微观层面
年龄（岁）32(29,35)32(28,35)-1.1090.267
性别
男190(50.9)183(49.1)1.4920.222
女1 669(54.3)1 406(45.7)
文化程度
高中及以下1 014(58.9)709(41.1)33.765<0.001
大专及以上845(49.0)880(51.0)
职业
医务工作者146(45.9)172(54.1)17.4430.004
企事业单位人员（不含医疗机构）469(51.4)443(48.6)
自由职业/个体经营者636(55.9)502(44.1)
农/牧民54(63.5)31(36.5)
其他272(54.3)229(45.7)
无业/家务待业282(57.1)212(42.9)
儿童健康状况
差347(57.5)256(42.5)3.8760.049
好1 512(53.1)1 333(46.9)
儿童家长健康状况
差513(57.2)384(42.8)5.2350.022
好1 346(52.8)1 205(47.2)
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否958(73.0)354(27.0)311.052<0.001
是901(42.2)1 235(57.8)
安全性认知-我担心非免疫规划疫苗会产生副作用
否932(53.1)824(46.9)1.0170.313
是927(54.8)765(45.2)
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否1 131(50.8)1 095(49.2)24.398<0.001
是728(59.6)494(40.4)
中观层面
前一年家庭年总收入（万元）
<101 276(58.4)909(41.6)48.245<0.001
≥10583(46.2)680(53.8)
家庭医疗费用负担
有负担1 150(58.4)820(41.6)36.798<0.001
没有负担709(48.0)769(52.0)
预防接种单位人员服务态度
不好396(60.8)255(39.2)15.441<0.001
好1 463(52.3)1 334(47.7)
接种单位服务时间能满足接种疫苗需求
不能93(55.4)75(44.6)0.1480.701
能1 766(53.8)1 514(46.2)
距离住家最近预防接种单位的路程（min）
>20288(57.4)214(42.6)2.8230.093
≤201 571(53.3)1 375(46.7)
能随时接种到打算为孩子接种的非免疫规划疫苗
否1 273(70.0)546(30.0)400.078<0.001
是586(36.0)1 043(64.0)
家人、朋友或同事推荐接种
否891(62.2)541(37.8)67.994<0.001
是968(48.0)1 048(52.0)
医务工作者建议接种
否543(53.9)465(46.1)0.0010.972
是1 316(53.9)1 124(46.1)
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否701(49.7)709(50.3)16.928<0.001
是1 158(56.8)880(43.2)
国家对疫苗质量监督管理
否874(58.9)610(41.1)26.000<0.001
是985(50.2)979(49.8)
国家或政府实施疫苗接种优惠政策
否672(77.6)194(22.4)261.052<0.001
是1 187(46.0)1 395(54.0)
), ArticleFig(id=1324051024499057329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=CN, label=表3, caption=

儿童家长非免疫规划疫苗接种意愿的单因素分析［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量疫苗接种意愿
不愿意愿意χ2/z值P值
微观层面
年龄（岁）32(29,35)32(28,35)-1.1090.267
性别
男190(50.9)183(49.1)1.4920.222
女1 669(54.3)1 406(45.7)
文化程度
高中及以下1 014(58.9)709(41.1)33.765<0.001
大专及以上845(49.0)880(51.0)
职业
医务工作者146(45.9)172(54.1)17.4430.004
企事业单位人员（不含医疗机构）469(51.4)443(48.6)
自由职业/个体经营者636(55.9)502(44.1)
农/牧民54(63.5)31(36.5)
其他272(54.3)229(45.7)
无业/家务待业282(57.1)212(42.9)
儿童健康状况
差347(57.5)256(42.5)3.8760.049
好1 512(53.1)1 333(46.9)
儿童家长健康状况
差513(57.2)384(42.8)5.2350.022
好1 346(52.8)1 205(47.2)
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否958(73.0)354(27.0)311.052<0.001
是901(42.2)1 235(57.8)
安全性认知-我担心非免疫规划疫苗会产生副作用
否932(53.1)824(46.9)1.0170.313
是927(54.8)765(45.2)
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否1 131(50.8)1 095(49.2)24.398<0.001
是728(59.6)494(40.4)
中观层面
前一年家庭年总收入（万元）
<101 276(58.4)909(41.6)48.245<0.001
≥10583(46.2)680(53.8)
家庭医疗费用负担
有负担1 150(58.4)820(41.6)36.798<0.001
没有负担709(48.0)769(52.0)
预防接种单位人员服务态度
不好396(60.8)255(39.2)15.441<0.001
好1 463(52.3)1 334(47.7)
接种单位服务时间能满足接种疫苗需求
不能93(55.4)75(44.6)0.1480.701
能1 766(53.8)1 514(46.2)
距离住家最近预防接种单位的路程（min）
>20288(57.4)214(42.6)2.8230.093
≤201 571(53.3)1 375(46.7)
能随时接种到打算为孩子接种的非免疫规划疫苗
否1 273(70.0)546(30.0)400.078<0.001
是586(36.0)1 043(64.0)
家人、朋友或同事推荐接种
否891(62.2)541(37.8)67.994<0.001
是968(48.0)1 048(52.0)
医务工作者建议接种
否543(53.9)465(46.1)0.0010.972
是1 316(53.9)1 124(46.1)
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否701(49.7)709(50.3)16.928<0.001
是1 158(56.8)880(43.2)
国家对疫苗质量监督管理
否874(58.9)610(41.1)26.000<0.001
是985(50.2)979(49.8)
国家或政府实施疫苗接种优惠政策
否672(77.6)194(22.4)261.052<0.001
是1 187(46.0)1 395(54.0)
), ArticleFig(id=1324051024587137714, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=EN, label=Table 4, caption=

Multivariable logistic regression analysis of parents’ willingness to vaccinate children with non-EPI vaccines

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β Wald χ2值P值OR（95%CI）
微观层面
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否1
是0.9550.084127.956<0.0012.597（2.201～3.065）
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否1
是-0.3930.08123.314<0.0010.675（0.575～0.792）
中观层面
前一年家庭年总收入（万元）
<101
≥100.2250.0798.0150.0051.252（1.072～1.463）
能随时接种到打算为孩子接种的非免疫规划疫苗
否1
是0.9920.079157.036<0.0012.696（2.309～3.149）
家人、朋友、同事等是否推荐过为孩子接种非免疫规划疫苗
否1
是0.2600.08210.1440.0011.297（1.105～1.522）
医务工作者建议接种
否1
是-0.1990.0875.2410.0220.820（0.691～0.972）
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否1
是-0.2400.0789.5220.0020.787（0.676～0.916）
国家或政府实施疫苗接种优惠政策
否1
是0.7580.10057.568<0.0012.133（1.754～2.594）
), ArticleFig(id=1324051024679412403, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324051016047534719, language=CN, label=表4, caption=

儿童家长非免疫规划疫苗接种意愿的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量β Wald χ2值P值OR（95%CI）
微观层面
益处认知-我相信接种非免疫规划疫苗能有效预防特定疾病
否1
是0.9550.084127.956<0.0012.597（2.201～3.065）
风险认知-我认为孩子很健康不需要打非免疫规划疫苗
否1
是-0.3930.08123.314<0.0010.675（0.575～0.792）
中观层面
前一年家庭年总收入（万元）
<101
≥100.2250.0798.0150.0051.252（1.072～1.463）
能随时接种到打算为孩子接种的非免疫规划疫苗
否1
是0.9920.079157.036<0.0012.696（2.309～3.149）
家人、朋友、同事等是否推荐过为孩子接种非免疫规划疫苗
否1
是0.2600.08210.1440.0011.297（1.105～1.522）
医务工作者建议接种
否1
是-0.1990.0875.2410.0220.820（0.691～0.972）
宏观层面
信任新闻或网络媒体所报导的疫苗负面信息
否1
是-0.2400.0789.5220.0020.787（0.676～0.916）
国家或政府实施疫苗接种优惠政策
否1
是0.7580.10057.568<0.0012.133（1.754～2.594）
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社会生态学视角下家长对儿童非免疫规划疫苗接种意愿影响因素分析
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彭雪清 , 张量智 , 高明月 , 李蕾
现代预防医学 | 疾病预防控制 2026,53(11): 2081-2087
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现代预防医学 |疾病预防控制 2026 , 53 (11) : 2081 -2087
社会生态学视角下家长对儿童非免疫规划疫苗接种意愿影响因素分析
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彭雪清, 张量智, 高明月, 李蕾
作者信息
  • 成都市疾病预防控制中心（成都市卫生监督所）免疫规划科，四川 成都 610041
通讯作者:
李蕾，E-mail：
作者简介:

彭雪清（1995—），女，硕士，医师，研究方向：疫苗可预防疾病控制与健康教育研究

Influencing factors of parents’ willingness to vaccinate children with non-expanded program on immunization vaccines—a social ecosystem theory perspective
Xue-qing PENG, Liang-zhi ZHANG, Ming-yue GAO, Lei LI
Affiliations
  • Department of Immunization Planning, Chengdu Center for Disease Control and Prevention (Chengdu Institute of Health Supervision), Chengdu, Sichuan 610041, China
出版时间: 2026-06-10 doi: 10.20043/j.cnki.MPM.202512496
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摘要
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目的

基于社会生态学理论（social ecosystem theory， SET）探究家长对儿童非免疫规划疫苗接种意愿及其影响因素。

方法

2024年8月，采用基于SET核心框架的自设问卷，通过在线问卷调查对成都市0～6岁儿童家长非免疫规划疫苗接种意愿情况开展横断面研究。利用多因素logistic回归分析影响非免疫规划疫苗接种意愿的因素。

结果

共收集3 448份有效问卷，46.1%的家长有为儿童接种非免疫规划疫苗的意愿。在微观层面，益处认知与家长为儿童接种非免疫规划疫苗的意愿呈正向关联（OR=2.60，95%CI：2.20～3.07），而低估风险认知与家长意愿呈负向关联（OR=0.68， 95%CI：0.58～0.79）；在中观层面，经济状况较好（OR=1.25， 95%CI：1.07～1.46）、疫苗接种服务可及性好（OR=2.70， 95%CI：2.31～3.15）、同伴的推荐（OR=1.30， 95%CI：1.11～1.52）与家长意愿呈正向关联，但医务工作者的建议与家长意愿呈负向关联（OR=0.82， 95%CI：0.69～0.97）。在宏观层面，信任媒体报导的疫苗负面消息与家长意愿呈负向关联（OR=0.79， 95%CI：0.68～0.92），而疫苗接种优惠政策与家长意愿呈正向关联（OR=2.13， 95%CI：1.75～2.60）。

结论

家长对儿童非免疫规划疫苗接种意愿受微观、中观、宏观多层嵌套关联的因素共同影响，未来有关提升儿童非免疫规划疫苗接种率的干预措施应考虑多层次的协同干预。

儿童家长  /  非免疫规划疫苗  /  社会生态学理论  /  接种意愿  /  影响因素
Objective

Based on social ecosystem theory (SET), this study investigated parents’ willingness to vaccinate their children with non-expanded program on immunization (non-EPI) vaccines and its influencing factors.

Methods

In August 2024, a cross-sectional study was conducted using a self-designed questionnaire based on the core framework of SET through an online questionnaire to assess the willingness of parents in Chengdu to vaccinate children aged 0-6 years with non-EPI vaccines. Multivariable logistic regression analysis was employed to identify factors influencing willingness to vaccinate children with non-EPI vaccines.

Results

A total of 3 448 valid questionnaires were collected, with 46.1% of parents expressing willingness to vaccinate children with non-EPI vaccines. At the micro level, perceived benefits were positively associated with parental willingness to vaccinate their children with non-EPI vaccines (OR=2.60, 95% CI: 2.20-3.07), while risk underestimation was negatively associated with parental willingness (OR=0.68, 95% CI: 0.58-0.79). At the meso level, favorable economic conditions (OR=1.25, 95% CI: 1.07-1.46), good vaccine service accessibility (OR=2.70, 95% CI: 2.31-3.15), and peer recommendations (OR=1.30, 95% CI: 1.11-1.52) were positively associated with parental willingness. Conversely, healthcare workers’ recommendations were negatively associated with parental willingness (OR=0.82, 95% CI: 0.69-0.97). At the macro level, trust in media reports of vaccine-related negative news was negatively associated with parental willingness (OR=0.79, 95% CI: 0.68-0.92), while preferential vaccination policies were positively associated with parental willingness (OR=2.13, 95% CI: 1.75-2.60).

Conclusion

Parents’ willingness to vaccinate children with non-EPI vaccines is influenced by factors at micro, meso and macro levels. Future interventions aimed at increasing vaccination rates for non-EPI vaccines should consider multi-level coordinated interventions.

Parents  /  Non-expanded program on immunization vaccines  /  Social ecosystem theory  /  Willingness to vaccinate  /  Influencing factors
彭雪清, 张量智, 高明月, 李蕾. 社会生态学视角下家长对儿童非免疫规划疫苗接种意愿影响因素分析. 现代预防医学, 2026 , 53 (11) : 2081 -2087 . DOI: 10.20043/j.cnki.MPM.202512496
Xue-qing PENG, Liang-zhi ZHANG, Ming-yue GAO, Lei LI. Influencing factors of parents’ willingness to vaccinate children with non-expanded program on immunization vaccines—a social ecosystem theory perspective[J]. Modern Preventive Medicine, 2026 , 53 (11) : 2081 -2087 . DOI: 10.20043/j.cnki.MPM.202512496
正文
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非免疫规划疫苗是免疫规划疫苗的重要补充，对预防特定年龄段儿童易感的、疾病负担较重的传染病（如水痘、流感、肺炎球菌性疾病等）具有不可替代的作用[1-2]。但在现阶段需由居民自愿、自费接种。我国儿童非免疫规划疫苗覆盖率不高[3],且全程免疫不完整的问题广泛存在[4-5]，已成为儿童免疫屏障中的薄弱环节。社会生态学理论（social ecosystem theory，SET）从微观（个体）、中观（人际/社区/组织）和宏观（社会/政策）三个层面系统地阐述影响个体行为的内在和外部环境因素[6-7]，并强调这三个层面并非孤立存在，而是相互嵌套、动态关联的，共同塑造个体的行为决策情境，对分析和理解个体行为具重要意义。本研究拟以SET作为理论框架，探索家长对儿童非免疫规划疫苗接种意愿的影响因素，为促进儿童非免疫规划疫苗接种相关策略提供参考。
1　对象与方法
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1.1　对象
四川省成都市常住人口中18岁以上的0～6岁儿童家长。
1.2　方法
1.2.1　抽样与调查方法
2024年8月，运用方便抽样方法对成都市常住人口中18岁以上的0～6岁儿童家长开展在线问卷调查。问卷通过问卷星平台制作并发放，由全市23个区（市）县所有常规预防接种门诊同步转发，邀请辖区内所有符合条件的受访对象自愿匿名填写。根据现况调查样本量计算公式：N=，其中Zα/2=1.96，容许误差d=0.05，前期文献报告家长非免疫规划疫苗接种意愿率范围为60.16%～83.79%（为保证研究检验效能，取最小意愿率60.16%）[8]，同时考虑20%无效问卷，估算得最小样本量为461人。实际共收集问卷3 599份，剔除填写时间<120s、规律性作答等问题问卷，最终有效问卷3 448份，有效回收率95.8%。有效样本覆盖全市所有区（市）县，各区样本量分布相对均匀（占总有效样本比例介于2.3%～9.1%）。
1.2.2　调查工具
调查采用自设问卷，基于充分文献回顾[8-10]和SET理论框架形成初稿，经5名传染病控制和疫苗接种领域专家对条目内容、表述及适用性评审后进行修订，并开展小范围线下预调查（n=30）对条目的可理解性和作答逻辑进行检验和优化。问卷所有条目均为单一指标问题，主要包括两部分内容。见图1。
（1）依据SET理论设计的问卷：微观层面包括个体特征（年龄、性别、职业、文化程度、健康状况等），对接种非免疫规划疫苗益处、安全性和风险相关认知；中观层面包括家庭经济状况和医疗负担，接种单位疫苗接种可及性、便利性和服务态度，家人、朋友或同事推荐和医务工作者建议等；宏观层面包括是否受媒体疫苗负面信息报导、疫苗质量监督管理、疫苗接种优惠政策的影响。
（2）疫苗接种意愿情况：“您总体上为孩子接种非免疫规划疫苗的愿意程度是？”被用于评估疫苗接种意愿，答案采用Likert 5级量表评估。参考既往同类研究[9]，将“非常愿意/比较愿意”判定为“愿意”（代表受访者有明确的主动接种意愿）；考虑到“一般”代表无明确主动接种意愿的疫苗犹豫状态，将其与“不太愿意/非常不愿意”一并判定为“不愿意”。
1.3　统计分析
采用R 4.5.0统计软件进行数据分析，双侧检验，检验水准α=0.05。通过中位数和四分位数、频数和构成比描述各变量分布情况。将SET中三个层面的因素作为自变量，疫苗接种意愿作为因变量（0=不愿意，1=愿意）进行单因素和多因素统计学检验。使用χ2检验和非参数Mann-Whitney U检验分析变量之间的差异，采用二分类logistic回归模型分析（Forward: LR法）探讨疫苗接种意愿的影响因素。方差膨胀因子（variance inflation factor, VIF）用于多重共线性诊断，以VIF<5作为参考阈值。Hosmer-Lemeshow用于检验拟合度。
1.4　伦理审查
本研究方案经成都市疾病预防控制中心伦理审查委员会（NO.2024022）批准通过；所有调查开展前均获得了研究对象的知情同意。
2　结果
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2.1　调查对象基本情况
3 448位受访者中，女性居多，占89.2%，本科/大专及以上学历占50.1%，家庭年总收入在10万元以下者占63.4%，82.5%的报告儿童和74.0%的儿童家长健康状况良好。见表1。
2.2　家长对儿童接种非免疫规划疫苗意愿及SET相关因素情况
3 448名受访者中，1 589名儿童家长（46.1%）有为儿童接种非免疫规划疫苗意愿。SET各层面因素分布如下：微观层面，61.9%的家长相信疫苗益处，而35.4%的家长存低估疾病风险；中观层面，仅47.2%的家长报告能随时接种到所需疫苗，58.5%的家长收到过同伴推荐接种；宏观层面，74.9%的家长表示会受到疫苗接种优惠政策的影响。见表2。
2.3　疫苗接种意愿的影响因素分析
2.3.1　单因素分析
家长文化程度、职业、自身及儿童健康状况、疫苗益处认知、疾病风险认知、家庭年收入、医疗费用负担、接种服务可及性、接种单位服务态度、同伴推荐、对疫苗负面媒体报道的信任度、疫苗质量监管信任度及疫苗接种优惠政策等因素，在接种意愿组间的分布差异均具有统计学意义（P<0.05）。见表3。
2.3.2　多因素分析
在微观层面，相信接种非免疫规划疫苗益处（OR=2.60,95%CI:2.20～3.07）与家长为儿童接种非免疫规划疫苗意愿呈正向关联，而低估疾病风险与家长意愿呈负向关联（OR=0.68, 95%CI:0.58～0.79）。在中观层面，经济状况（OR=1.25,95%CI:1.07～1.46）、疫苗接种可及性好、（OR=2.70,95%CI:2.31～3.15）、家人/朋友/同事等的推荐（OR=1.30, 95%CI:1.11～1.52）均与家长意愿呈正向关联，但医务工作者的建议与家长意愿呈负向关联（OR=0.82, 95%CI:0.69～0.97）。在宏观层面，信任媒体报导的疫苗负面消息与家长意愿呈负向关联（OR=0.79, 95%CI:0.68～0.92），疫苗接种优惠政策与家长意愿呈正向关联（OR=2.13, 95%CI:1.75～2.60）。所有自变量VIF值范围为1.030～1.361，均<5，无显著多重共线性问题。Hosmer-Lemeshow检验P>0.05，模型拟合度良好。见表4。
3　讨论
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本次研究发现，46.1%的儿童家长愿意为儿童接种非免疫规划疫苗，该比例显著低于国内其他同类全国性研究结果[8-10]。接种疫苗的意愿薄弱是与接种率低密切相关的主要因素[11]。
从社会生态学理论的视角出发，本研究发现，家长对儿童非免疫规划疫苗的接种意愿是其个体认知、所处社会环境以及信息环境与宏观政策共同作用的结果。在微观层面，个体的认知与信念与疫苗接种意愿的密切相关。相信接种非免疫规划疫苗能带来益处的家长，其为子女接种的意愿是持怀疑态度家长的2.6倍，这与唐智峰等[12]的研究结论类似。当家长明确认识到接种非免疫规划疫苗所带来的益处时，他们采取疫苗接种预防行为的动机就会增强。与上述发现相对应，低估相关疾病风险的家长，其接种意愿相对较低。这可能与他们存在“乐观偏见”有关，即低估非免疫规划疫苗所预防疾病的实际威胁。如Navin等[13]发现相较于麻疹、乙肝等传统上被高度警惕的疾病，广泛认为水痘并不严重抑制了其疫苗接种率。因此，应将清晰、有力地传递疫苗的保护价值和多重益处作为健康教育和沟通的重点，同时还须纠正家长对疾病风险的低估，使其认识到“不接种”所面临的潜在威胁[14]。值得注意的是，这种微观层面的认知并非孤立存在，其形成与改变会受多层外部因素的影响。如，同伴的正面推荐能强化家长对疫苗益处的信念[15]，媒体负面报道可能加剧其对疫苗安全风险的担忧[16]。
在中观层面发现，家庭经济状况较好的家长疫苗接种意愿越高，这也侧面反映了这类疫苗的“自费”属性，经济状况越好相对更易承担非免疫规划疫苗费用[17]。此外，家庭经济状况较好的家庭，健康信息获取渠道更多元，能获取更充分的健康信息[18]，可能使其形成更理性的疫苗益处-风险认知，这提示社会经济地位可能塑造微观层面的个体认知。疫苗接种可及性也是与家长疫苗接种意愿密切相关的重要现实因素。即使有接种意愿，但若接种过程充满障碍（时间成本、精力成本等），意愿也很难转化为行动[19]。接种服务可及性的提升能为个体认知的正向转变提供现实场景支持。本研究发现仅47.2%的家长报告能随时接种到打算为孩子接种的非免疫规划疫苗，这提示，应进一步注重提升预防接种服务体系的便利性、高效性。研究还发现，同伴的推荐与家长的接种意愿呈正向关联。在做不确定的决策时，人们可能会倾向于参考同龄群体的经验。Bonner等[20]的研究也发现若家人或朋友给出正面推荐，疫苗接种意愿会提高1.9倍。同伴推荐本质上是通过社会学习作用于微观认知，为缺乏专业知识或犹豫不决的家长提供决策参考。这表明，干预策略可以利用社区或家长社群网络开展同伴教育和正向经验分享。另外，本研究发现，医务工作者的建议与儿童家长接种意愿负相关，这一结果与传统观点[21-22]相悖。可能与医务工作者的推荐沟通方式有关，若医生在给出建议时解释不充分，如过度强调潜在不良反应或未充分解释风险与收益的权衡，可能会加剧家长的犹豫。此外，这一反常发现可能也与宏观信息环境有关，媒体负面报导可能使家长对医务工作者产生防御性抵触，即使医生给出合理建议，也难以抵消其已被媒体塑造的不信任感[23]。但其背后可能存在多种复杂的机制，有待进一步深入探究。
宏观层面分析结果表明，信任媒体关于疫苗负面消息报道的家长接种意愿越低。这进一步证明了媒体环境在塑造公众疫苗态度方面的巨大影响力。黄琦等的研究显示，“长春长生疫苗事件”导致儿童家长对非免疫规划疫苗的信任度和接种意愿普遍下降，部分网络媒体夸大其词、制造谣言，引发公众的恐慌情绪，对疫苗安全性和有效性产生担忧，加剧了疫苗犹豫[22]。可见，要维护公众疫苗信心，相关机构必须要对媒体环境中疫苗相关错误和虚假信息进行有效管理和应对，加强对媒体的正确利用，以有效地科普疫苗信息。结果还表明，疫苗接种优惠政策与儿童家长的接种意愿呈正相关，大多数人（74.9%）表示若国家或政府实施优惠政策，他们会愿意为儿童接种非免疫规划疫苗。从多层次视角看，优惠政策不仅直接作用于家长决策中的“成本端”，降低中观层面的经济门槛，还从宏观政策层面释放出支持信号，增强家长的接种信心。当前，我国多个省市已实施地方性扩大免疫规划疫苗政策，并取得了相当成效，如苏州市的水痘疫苗政策[24]。本研究这一发现，进一步为未来更多高效益、高负担的非免疫规划疫苗逐步纳入相关优惠政策提供了证据支持。宏观因素是塑造接种意愿的顶层结构性因素，其作用主要通过渗透中观服务与人际环境、影响个体微观认知实现[6]。
本研究也存在一定局限性，一是本研究的数据仅来自于特定城市，结果外推时需要谨慎考虑地域差异。二是将非免疫规划疫苗看作整体进行研究，忽略了不同疫苗的差异（如价格、剂次等），但整体分析有助于快速识别“共性”的相关因素。三是本研究为横断面设计，仅能揭示关联，无法推断因果，未来需纵向研究进一步验证。
综上，本研究基于SET的分析表明，儿童家长的非免疫规划疫苗接种意愿并非三个层面因素独立作用的简单加和，而是微观、中观、宏观多层因素嵌套联动的结果。提升儿童非免疫规划疫苗接种覆盖率的路径，源于家长的正确认知，依托于社区预防接种服务网络的便捷性和社会规范，并依赖健康媒体环境和政策支持。需通过多层次协同干预，才能提升儿童非免疫规划疫苗接种率，筑牢儿童免疫屏障。
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  • 成都市疾病预防控制中心2024年度科研课题(20240206)
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2026年第53卷第11期
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doi: 10.20043/j.cnki.MPM.202512496
  • 接收时间：2025-12-28
  • 首发时间：2026-11-02
  • 出版时间：2026-06-10
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  • 收稿日期：2025-12-28
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成都市疾病预防控制中心2024年度科研课题(20240206)
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    成都市疾病预防控制中心（成都市卫生监督所）免疫规划科，四川 成都 610041

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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